Mental Health and Parenting

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Transcript of Mental Health and Parenting

Mental Health and ParentingWhat this training will coverThis training will cover information about the risks and strengths that arise when a person is a parent with a mental illness. The training will also provide information about how parental mental health dysfunction can impact children in the home.

Important to noteHaving a diagnosis of a mental health condition in isolation is not sufficient for an assessment of high or moderate risk to a child or family. Why do child protection workers need to understand mental health?A study completed in Europe, UK, Australia, Canada, and USA: 10-42% of child protection matters involved parental mental illness as a risk factor; ¼ of all new referrals to child protection services in UK involved mental health issues; Factors contributing to the impact of parental mental illness on childrenTHANK YOU!Mental health training 2RefresherWhat do you remember from Mental Health Training 1?Additional factors in relation to mental health may increase the risk, including substance misuse, and domestic and family violence. Type and severity of illnessThe more “pervasive and persistent” the condition, the higher risk to the child. Schizophrenia: Depression: Study in Wacol, Queensland (participants were subject to orders to retain them in mental health facilities)Approximately 50% of women with schizophrenia retained custody of their children, however of these women a significant proportion had their children residing with other family members. Medication and unhealthy lifestyle in pregnant women with schizophrenia led to high rates of premature birth and low birth-weight in their infants. Mother-child interaction can be impaired due to the behaviours associated with this condition. Frequently associated with low income, perceived lack of social support, marital discord (including domestic and family violence), and dysfunctional family environments. Available treatment and support: Individual characteristics: Social environment and family context: Child characteristics: Direct impacts on childrenIn infancy: Foetal exposure to conditions including mother’s stress and side effects of medication can lead to increased risk of perinatal complications and behavioural issues, for example increased irritability during infancy. Some evidence of neuro-behavioural disturbances in infants born to mothers using antidepressant medication during pregnancy.

Parent-child attachment Childhood developmenthigher rates of behavioural, developmental, and emotional problems in children of parents with a mental disorder compared to the general community. Child’s mental health Increased risk of developing mental health issues later in life Study in Denmark (2011) of all children born in 1966. Those who attempted suicide for the first time between the ages of 14 and 27 years indicated that the first-time incident was linked to parental psychiatric disorder. Increased risk of entering out-of-home care Increased risk of experiencing relationship difficultiesIncreased risk of engaging in antisocial behaviours: Study in the United States indicated that juvenile offenders with mothers with mental illness are four times more likely to engage in serious criminal behaviours. “Invisible Children”Children caring for parents with mental illness Depression and parentingAttachment: 2 schools of thought: no impact vs. disrupted parenting experiences. Personality disorders are difficult to diagnose and treat. Often comorbid with substance misuse in parents. “Long-standing and maladaptive patterns of perceiving and responding to other people and to stressful circumstances.” Personality Disorders and Parenting“Among this group will be found some of the most difficult to manage and dangerous parents who are a severe risk to children’s safety.” Post-natal depression and parenting Postnatal depression (also known as postpartum depression): Said to effect 14% of new mothers in Australia; Acute psychosis and antenatal depression exacerbated by pregnancy and childbirth.

Early experience of a depressed parent or caregiver may have an enduring effect. Long-term impact on neuroendocrine regulatory processes. Abnormal cortisol levels in the adolescent children of women who experienced PND/PPD. Case studiesThe "F" FamilyThe "M" FamilyThe "A" FamilyMother diagnosed with depression and Munchausen by Proxy Syndrome Mother refused to take medication and engage with a therapist or psychologist Mother’s MbPS included behaviours which induced anxiety in the seven year old child resulting in his displaying behaviours including aggression in settings such as school and social environments. Tommy was removed from school by his mother, who stated that she was home-schooling him, however standardized testing and information obtained from Department of Education did not support this. Mother with organic schizophrenia (i.e. not induced by substance use). Symptoms included visual and audio hallucinations, thought disorders, fundamental distortions in thinking. Mother believed that there were people paid by her ex-husband and father of her youngest child, who were watching the family in their home and had installed video cameras in the home. Mother also believed that there were people coming into the home when the family were sleeping, so she worked with the children on a schedule so that at least one of them was awake at all times. Oldest son, Joshua, exhibiting antisocial behaviours including school abscondance, criminal behaviour, and violence towards mother. Mother demonstrating behaviours consistent with depression, anxiety, and post-traumatic stress disorder. Mother denied experiencing mental health dysfunction, however agreed to speak with a psychologist. This stopped when psychologist challenged mother by providing a diagnosis. Due to the cyclical nature of mental health, provided an acceptable level of support is available at all stages of the cycle, the impact on the child and family should be negligible. Limited data is available in Australia in terms of the relation between the presence of mental health issues, and contact with child protection authorities. Available data: 28-31% of children subject to institutional care were exposed to problematic parental mental health dysfunction. If a parent is able to demonstrate an appropriate level of insight into their mental health condition, it’s impact on the family, and effective treatment options, the risk to the children should be low. Social issues such as economic wellbeing of the family, substance misuse, domestic and family violence, and availability of support from extended family and friends can reduce the level of risk. AgeBehavioursTemperamentIllnessDisabilityLevel of resilienceStudies indicate that: Likely to be less happy than children in the general population More depressedLower self-esteem More likely to leave home at an earlier age Specific to children caring for a parent with schizophrenia: Increased isolation Increased parentification Feeling the need to hide distress due to fear, shame and stigma – leading to tendencies to become increasingly quiet and good to maintain a sense of calm and control. Behaviour problems: Links between depression and the internalisation/externalisation of children’s emotional responses to conflict and stress Children with parents with depression displayed increased rates of conduct disordersChildren caring for depressed parents: Difficult behaviours; Loss of appetite; Sleeplessness; Playing less with friends; Being less attentive at school. Parenting behaviour: Clear association between depression and less competent or responsive parenting; Parenting safety practices were observed to be significantly reduced in mothers with high levels of depressive symptoms.